Executive Editor: Fergal Monsell General Editor: Chris Colton

Authors: Andrew Howard, James Hunter, Theddy Slongo

Pediatric proximal femur

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Glossary

31-E/1.1 - Traumatic epiphysiolysis, SH I

Please select a treatment option:
Treatment Main indication Skill Equipment
Hip spica Stable, incomplete, or virtually nondisplaced fracture in a younger child Some specialized surgical experience Basic equipment only
In situ fixation with K-wires or screws Stable, incomplete, or virtually nondisplaced fractures Some specialized surgical experience Simple surgical and imaging resources
Open reduction, K-wire fixation Displaced fracture in younger children, angular stability not required Highly experienced and skilled surgeon Simple surgical and imaging resources
Open reduction, screw fixation Displaced fracture in younger children, angular stability not required Highly experienced and skilled surgeon Simple surgical and imaging resources

31-E/2.1 - Epiphysiolysis with metaphyseal wedge, SH II

Please select a treatment option:
Treatment Main indication Skill Equipment
Hip spica Stable, incomplete, or virtually nondisplaced fracture in a younger child Some specialized surgical experience Basic equipment only
In situ fixation with K-wires or screws Stable, incomplete, or virtually nondisplaced fractures Some specialized surgical experience Simple surgical and imaging resources
Open reduction, K-wire fixation Displaced fracture in younger children, angular stability not required Highly experienced and skilled surgeon Simple surgical and imaging resources
Open reduction, screw fixation Displaced fracture in younger children, angular stability not required Highly experienced and skilled surgeon Simple surgical and imaging resources
Open reduction, pediatric hip locking plate Salter-Harris II fractures with a large metaphyseal fragment Highly experienced and skilled surgeon Full specialized surgical and imaging resources

31-E/7 - Avulsion of/by the ligament of the head of the femur

Please select a treatment option:
Treatment Main indication Skill Equipment
Removal of osteochondral fragment Small fragments which cannot be fixed Highly experienced and skilled surgeon Simple surgical and imaging resources
Open reduction, resorbable pin fixation Fragments that are largely cartilaginous Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Open reduction, headless screw fixation Osteochondral fragments with enough bone for screw fixation Highly experienced and skilled surgeon Full specialized surgical and imaging resources

31-E/8 - Intraarticular flake(s)

Please select a treatment option:
Treatment Main indication Skill Equipment
Removal of osteochondral fragment Small fragments which cannot be fixed Highly experienced and skilled surgeon Simple surgical and imaging resources
Open reduction, resorbable pin fixation Fragments that are largely cartilaginous Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Open reduction, headless screw fixation Osteochondral fragments with enough bone for screw fixation Highly experienced and skilled surgeon Full specialized surgical and imaging resources

31-M/2.1 I - Incomplete midcervical

Please select a treatment option:
Treatment Main indication Skill Equipment
Hip spica Stable, incomplete fracture in a younger child Some specialized surgical experience Basic equipment only
In situ fixation with K-wires or screws Stable, incomplete fracture Some specialized surgical experience Simple surgical and imaging resources
Pediatric hip locking plate Incomplete fractures that require angular stability to avoid later displacement (more distal fracture, eg, basicervical, trochanteric) Highly experienced and skilled surgeon Full specialized surgical and imaging resources

31-M/2.1 II - Incomplete basicervical

Please select a treatment option:
Treatment Main indication Skill Equipment
Hip spica Stable, incomplete fracture in a younger child Some specialized surgical experience Basic equipment only
In situ fixation with K-wires or screws Stable, incomplete fracture Some specialized surgical experience Simple surgical and imaging resources
Pediatric hip locking plate Incomplete fractures that require angular stability to avoid later displacement (more distal fracture, eg, basicervical, trochanteric) Highly experienced and skilled surgeon Full specialized surgical and imaging resources

31-M/2.1 III - Incomplete transtrochanteric

Please select a treatment option:
Treatment Main indication Skill Equipment
Hip spica Stable, incomplete fracture in a younger child Some specialized surgical experience Basic equipment only
In situ fixation with K-wires or screws Stable, incomplete fracture Some specialized surgical experience Simple surgical and imaging resources
Pediatric hip locking plate Incomplete fractures that require angular stability to avoid later displacement (more distal fracture, eg, basicervical, trochanteric) Highly experienced and skilled surgeon Full specialized surgical and imaging resources

31-M/3.1 I - Complete midcervical, simple

Please select a treatment option:
Treatment Main indication Skill Equipment
Open reduction, K-wire fixation Displaced fracture in younger children, pediatric hip locking plate, or equivalent, not available Highly experienced and skilled surgeon Simple surgical and imaging resources
Open reduction, screw fixation Displaced fracture in a more proximal location Highly experienced and skilled surgeon Simple surgical and imaging resources
Open reduction, pediatric hip locking plate Method of choice for any displaced fracture Highly experienced and skilled surgeon Full specialized surgical and imaging resources

31-M/3.1 II - Complete basicervical, simple

Please select a treatment option:
Treatment Main indication Skill Equipment
Open reduction, K-wire fixation Displaced fracture in younger children, pediatric hip locking plate, or equivalent, not available Highly experienced and skilled surgeon Simple surgical and imaging resources
Open reduction, screw fixation Displaced fracture in a more proximal location Highly experienced and skilled surgeon Simple surgical and imaging resources
Open reduction, pediatric hip locking plate Method of choice for any displaced fracture Highly experienced and skilled surgeon Full specialized surgical and imaging resources

31-M/3.2 II - Complete basicervical, multifragmentary

Please select a treatment option:
Treatment Main indication Skill Equipment
Open reduction, pediatric hip locking plate Method of choice for any displaced fracture Highly experienced and skilled surgeon Full specialized surgical and imaging resources

31-M/3.1 III - Complete, transtrochanteric, simple

Please select a treatment option:
Treatment Main indication Skill Equipment
Open reduction, pediatric hip locking plate All trochanteric fractures Highly experienced and skilled surgeon Full specialized surgical and imaging resources
ESIN Children up to 6-8 years of age (depending on body size) Highly experienced and skilled surgeon Full specialized surgical and imaging resources

31-M/3.2 III - Complete transtrochanteric, multifragmentary

Please select a treatment option:
Treatment Main indication Skill Equipment
Open reduction, pediatric hip locking plate All trochanteric fractures Highly experienced and skilled surgeon Full specialized surgical and imaging resources
ESIN Children up to 6-8 years of age (depending on body size) Highly experienced and skilled surgeon Full specialized surgical and imaging resources

31-M/7 - Avulsion of the greater or lesser trochanter

Please select a treatment option:
Treatment Main indication Skill Equipment
Nonoperative treatment Displacement < 1.5-2.0 cm for the lesser trochanter and < 1 cm for the greater trochanter Basic surgical experience, no specialized skills Basic equipment only
Open reduction, tension band (greater trochanter) Displacement > 1 cm, split avulsion fragment Some specialized surgical experience Basic equipment only
Open reduction, screw fixation (greater trochanter) Displacement > 1 cm, intact fragment Some specialized surgical experience Basic equipment only
*Skill
Basic surgical experience, no specialized skills Basic surgical experience, no specialized skills
Some specialized surgical experience Some specialized surgical experience
Highly experienced and skilled surgeon Highly experienced and skilled surgeon
*Equipment
Basic equipment only Basic equipment only
Simple surgical and imaging resources Simple surgical and imaging resources
Full specialized surgical and imaging resources Full specialized surgical and imaging resources

v1.0 2017-12-04